Defense Sexual Assault Incident Reporting

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 2910-4 CATCH A SERIAL OFFENDER PROGRAM EXPLANATION AND NOTIFICATION INFORMATION FOR SEXUAL ASSAULT VICTIMS	Form	New	Available
Form DD Form 2910-4 Catch a Serial Offender Program Explanation and Notification Information for Sexual Assault Victims	Form	New	Repair queued
Form DD Form 2910-3 Return of Victim’s Personal Property in Restricted Reporting Sexual Assaults Cases Collected During a Sexual Assault Forensic Examination (SAFE)	Form and Instruction	New	Repair queued
Form DD Form 2910-3 Return of Victim's Personal Property in Restricted Reporting Sexual Assaults Cases Collected During a Sexual Assault Forensic Examination (SAFE)	Form and Instruction	New	Repair queued
Form DD Form 2910-1 Replacement of Lost DD Form 2910 Victim Reporting Preference Statement	Form	Modified	Repair queued
Form DD Form 2910-2 Retaliation Reporting Statement for Unrestricted Sexual Assault Cases	Form	Modified	Repair queued
Form DD Form 2910-2 Defense Sexual Assault Incident Supplementary Reporting	Form	Modified	Repair queued
Form DD Form 2910 Victim Reporting Preference Statement	Form	Modified	Repair queued
Form DD Form 2965 Defense Sexual Assault Incident Database (DSAID) Data Form	Form	Modified	Repair queued
Form DD Form 2965 Defense Sexual Assault Incident Restricted Reporting	Form	Modified	Repair queued
Form DD Form 2910 Victim Reporting Preference Statement	Form	Modified	Repair queued
Form DD Form 2965 Defense Sexual Assault Incident Database (DSAID) Data Form	Form	Modified	Available
Form DD Form 2965 Defense Sexual Assault Incident Unrestricted Reporting	Form	Modified	Repair queued
0704-0482_SSA_1.26.22.docx	Supporting Statement A	Uploaded 2022-01-26	Repair queued
DSAID_SSN _2019.pdf	Supplementary Document	Uploaded 2021-10-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
250687	Catch a Serial Offender Program Explanation and Notification Information for Sexual Assault Victims	Form	New	CATCH A SERIAL OFFENDER PROGRAM EXPLANATION AND NOTIFICATION INFORMATION FOR SEXUAL ASSAULT VICTIMS
250687	Catch a Serial Offender Program Explanation and Notification Information for Sexual Assault Victims	Form	New
247157	Return of Victim's Personal Property in Restricted Reporting Sexual Assaults Cases Collected During a Sexual Assault Forensic Examination (SAFE)	Form and Instruction	New	Return of Victim’s Personal Property in Restricted Reporting Sexual Assaults Cases Collected During a Sexual Assault Forensic Examination (SAFE)
247157	Return of Victim's Personal Property in Restricted Reporting Sexual Assaults Cases Collected During a Sexual Assault Forensic Examination (SAFE)	Form and Instruction	New
234081	Defense Sexual Assault Incident Supplementary Reporting	Form	Modified	Replacement of Lost DD Form 2910 Victim Reporting Preference Statement
234081	Defense Sexual Assault Incident Supplementary Reporting	Form	Modified	Retaliation Reporting Statement for Unrestricted Sexual Assault Cases
234081	Defense Sexual Assault Incident Supplementary Reporting	Form	Modified
234080	Defense Sexual Assault Incident Restricted Reporting	Form	Modified	Victim Reporting Preference Statement
234080	Defense Sexual Assault Incident Restricted Reporting	Form	Modified	Defense Sexual Assault Incident Database (DSAID) Data Form
234080	Defense Sexual Assault Incident Restricted Reporting	Form	Modified
200363	Defense Sexual Assault Incident Unrestricted Reporting	Form	Modified	Victim Reporting Preference Statement
200363	Defense Sexual Assault Incident Unrestricted Reporting	Form	Modified	Defense Sexual Assault Incident Database (DSAID) Data Form
200363	Defense Sexual Assault Incident Unrestricted Reporting	Form	Modified

ICR Details

OMB Control No: 0704-0482	ICR Reference No: 202105-0704-001
Status: Historical Active	Previous ICR Reference No: 201811-0704-002
Agency/Subagency: DOW/DODDEP	Agency Tracking No:
Title: Defense Sexual Assault Incident Reporting
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/15/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/26/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2025	36 Months From Approved	03/31/2022
Responses	8,247	0	730
Time Burden (Hours)	17,350	0	1,780
Cost Burden (Dollars)	456,495	0	46,835

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Abstract: Public Law 110-417 mandated the implementation of a centralized, case-level database for the collection, in a manner consistent with Department of Defense regulations for Unrestricted and Restricted Reporting, and maintenance of information regarding sexual assaults involving a member of the Armed Forces, including information, if available, about the nature of the assault, the victim, the offender, and case outcomes in connection with the assault. The law also required the database to be used to develop and implement congressional reports required by law.

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Authorizing Statute(s): PL: Pub.L. 110 - 417 563 Name of Law: National Defense Authorization Act for Fiscal Year 2009
   US Code: 10 USC 136 Name of Law: Under Secretary of Defense for Personnel and Readiness
   US Code: 10 USC 3013 Name of Law: Secretary of the Army
   US Code: 10 USC 5013 Name of Law: Secretary of the Navy
   US Code: 10 USC 8013 Name of Law: Secretary of the Air Force
   US Code: 32 USC 102 Name of Law: National Guard
   EO: EO 9397 Name/Subject of EO: SSN
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 63004	11/15/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 3514	01/24/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Catch a Serial Offender Program Explanation and Notification Information for Sexual Assault Victims	DD Form 2910-4	CATCH A SERIAL OFFENDER PROGRAM EXPLANATION AND NOTIFICATION INFORMATION FOR SEXUAL ASSAULT VICTIMS
Defense Sexual Assault Incident Restricted Reporting	DD Form 2965, DD Form 2910	Defense Sexual Assault Incident Database (DSAID) Data Form ,   Victim Reporting Preference Statement
Defense Sexual Assault Incident Supplementary Reporting	DD Form 2910-2, DD Form 2910-1	Retaliation Reporting Statement for Unrestricted Sexual Assault Cases ,   Replacement of Lost DD Form 2910 Victim Reporting Preference Statement
Defense Sexual Assault Incident Unrestricted Reporting	DD Form 2910, DD Form 2965	Defense Sexual Assault Incident Database (DSAID) Data Form ,   Victim Reporting Preference Statement
Return of Victim's Personal Property in Restricted Reporting Sexual Assaults Cases Collected During a Sexual Assault Forensic Examination (SAFE)	DD Form 2910-3	Return of Victim’s Personal Property in Restricted Reporting Sexual Assaults Cases Collected During a Sexual Assault Forensic Examination (SAFE)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	8,247	730	0	7,517	0	0
Annual Time Burden (Hours)	17,350	1,780	0	15,570	0	0
Annual Cost Burden (Dollars)	456,495	46,835	0	409,660	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden has increased since the previous approval due to an increase of respondents and the new collection of information reported on DD Form 2910-3 and DD2910-4.

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Annual Cost to Federal Government: $620,227

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/26/2022

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